Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan.
J Cardiol. 2010 Jan;55(1):77-83. doi: 10.1016/j.jjcc.2009.09.001. Epub 2009 Nov 5.
Recurrent acute myocardial infarction (AMI) is a disastrous condition with high in-hospital morbidity and mortality. However, the relation between location of previous myocardial infarction (MI) and in-hospital outcome in repeat-AMI patients undergoing primary percutaneous coronary intervention (PCI) remains unclear.
Using the AMI-Kyoto Multi-Center Risk Study database, clinical background, angiographic findings, results of primary PCI, and in-hospital prognosis were retrospectively compared between primary PCI-treated AMI patients with previous anterior MI (anterior group, n=151) and those with previous non-anterior MI (non-anterior group, n=157). Clinical backgrounds, angiographic findings, results of primary PCI, and in-hospital outcome did not differ significantly between the two groups. On multivariate analysis, Killip class > or =3 at admission, number of diseased vessels > or =2 or diseased left main trunk at initial coronary angiography, and age were the independent predictors of in-hospital mortality in the recurrent-AMI patients, but not the anterior location of previous MI.
These results suggest that among recurrent-AMI patients undergoing primary PCI, in-hospital prognosis mostly depends on the severity of acute heart failure at the onset and the residual myocardial ischemia rather than previous MI sites.
复发性急性心肌梗死（AMI）是一种灾难性疾病，具有较高的院内发病率和死亡率。然而，在接受直接经皮冠状动脉介入治疗（PCI）的复发性 AMI 患者中，既往心肌梗死（MI）的部位与院内预后之间的关系尚不清楚。
利用 AMI-京都多中心风险研究数据库，回顾性比较了 151 例既往前壁 MI（前壁组）和 157 例既往非前壁 MI（非前壁组）接受直接 PCI 治疗的 AMI 患者的临床背景、血管造影结果、直接 PCI 结果和院内预后。两组患者的临床背景、血管造影结果、直接 PCI 结果和院内预后无显著差异。多变量分析显示，入院时 Killip 分级≥3、初始冠状动脉造影时病变血管≥2 支或病变左主干、年龄是复发性 AMI 患者院内死亡的独立预测因素，但既往 MI 部位不是。
这些结果表明，在接受直接 PCI 的复发性 AMI 患者中，院内预后主要取决于急性心力衰竭发作时的严重程度和残余心肌缺血，而不是既往 MI 部位。
